It’s July 2023 and in this video we over health insurance network benefits.
We’ll start by defining, what is a health insurance network? Basically, insurance companies contract with healthcare providers, creating a list of ‘in-network’ providers that you can utilize for your healthcare needs. Networks consist of primary care providers, specialists, pharmacies, and hospitals and urgent care centers.
In-network benefits are the insurance coverage you receive when seeking care at one of these in-network providers. These providers are where you will receive the richest benefits from your health insurance.
Out-of-network benefits are the insurance benefits you receive when seeking care at a provider that is not inside the insurance companies network of providers. These providers are where you will receive less extensive benefits from your health insurance. On some health insurance plans, there is no coverage at all for care sought at an out-of-network provider.
If you have a Preferred Provider Organization (PPO) plan, you can seek care outside of the health insurance network, but the benefits are not as rich as if you seek care inside the network. If you have an Exclusive Provider Organization (EPO) plan, you will receive no insurance coverage if you seek healthcare outside of the health insurance network. If you have a Health Maintenance Organization (HMO) plan, typically you will only receive insurance coverage if you seek healthcare inside the network AND seeking care usually requires a referral from your primary care provider.
One situation that worries people when it comes to in-network and out-of-network health insurance benefits is their ability to access healthcare when travelling internationally. Emergency care sought when travelling will typically be covered by your insurance plan subject to in-network and out-of-network policies, just as it would be at home. However, medical tourism, or elective healthcare that takes place abroad, is typically not covered by health insurance plans.
Hopefully this clears up in and out of network health insurance, but if you have questions, reach out to us here at Mountain View Insurance!
